Purpose: In posterior cruciate ligament reconstruction, the tibial tunnel/graft angle (or killer turn) has been implicated in graft failure when using transtibial tunnel placement. The graft/femoral tunnel angle (or critical corner) can also contribute to shear stress and early graft failure. The purpose of this study was to quantitate the killer turn angle in flexion and extension and to compare critical corner angles using outside-in and inside-out techniques for femoral tunnel placement.
Type Of Study: A cadaveric, biomechanical comparison.
Methods: One transtibial tunnel and 2 femoral tunnels were marked with guidewires in 9 fresh-frozen cadaveric knees. The killer turn and the 2 critical corner angles were measured at 90 degrees of flexion and full extension on fluoroscopic images. Results were analyzed using a Student t test with paired data.
Results: The average killer turn was 70 degrees +/- 12 degrees and 78 degrees +/- 7 degrees in flexion and extension, respectively. Knee extension significantly increased the killer turn angle (P = .048). The average critical corner was 50 degrees +/- 16 degrees and -14 degrees +/- 18 degrees with the outside-in technique versus 87 degrees +/- 8 degrees and 27 degrees +/- 14 degrees with the inside-out technique in flexion and extension, respectively. The inside-out technique significantly increased the critical corner in flexion (P = .00007) and extension (P = .00005). At 90 degrees of flexion, the critical corner angle using the inside-out technique significantly exceeded the killer turn angle (P = .003).
Conclusions: We recommend the outside-in technique for femoral tunnel placement to reduce the graft/femoral tunnel angle. Using the inside-out technique can significantly sharpen the critical corner, causing it to exceed the killer turn in flexion.
Clinical Relevance: This study indicates that significantly lower graft/femoral tunnel angles can be obtained when using the outside-in technique for femoral tunnel placement when compared with the inside-out technique. This may translate to lower rates of graft failure in clinical application, although further clinical studies are needed.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.arthro.2005.03.011 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Germs, infections, and the erratic 'natural laboratory' of Antarctica: from Operation Snuffles to the Killer Kleenex.
Med Hist
January 2025
University of Birmingham, Birmingham, UK.
Historians have written copiously about the shift to 'germ theories' of disease around the turn of the twentieth century, but in these accounts an entire continent has been left out: Antarctica. This article begins to rebalance our historiography by bringing cold climates back into the story of environmental medicine and germ theory. It suggests three periods of Antarctic (human) microbial research - heroic sampling, systematic studies, and viral space analogue - and examines underlying ideas about 'purity' and infection, the realities of fieldwork, and the use of models in biomedicine.
View Article and Find Full Text PDFColey's Toxin to First Approved Therapeutic Vaccine-A Brief Historical Account in the Progression of Immunobiology-Based Cancer Treatment.
Biomedicines
November 2024
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancer immunobiology is one of the hot topics of discussion amongst researchers today, and immunotherapeutic modalities are among the selected few emerging approaches to cancer treatment that have exhibited a promising outlook. However, immunotherapy is not a new kid on the block; it has been around for centuries. The origin of cancer immunotherapy in modern medicine can be traced back to the initial reports of spontaneous regression of malignant tumors in some patients following an acute febrile infection, at the turn of the twentieth century.
View Article and Find Full Text PDFElevated Galectin-3 levels in the tumor microenvironment of ovarian cancer - implication of ROS mediated suppression of NK cell antitumor response via tumor-associated neutrophils.
Front Immunol
January 2025
Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden.
Introduction: Ovarian cancer is a lethal disease with low survival rates for women diagnosed in advanced stages. Current cancer immunotherapies are not efficient in ovarian cancer, and there is therefore a significant need for novel treatment options. The β-galactoside-binding lectin, Galectin-3, is involved in different immune processes and has been associated with poor outcome in various cancer diagnoses.
View Article and Find Full Text PDFHLA-E: Immune Receptor Functional Mechanisms Revealed by Structural Studies.
Immunol Rev
January 2025
Nuffield Department of Medicine, Center for Immuno-Oncology, University of Oxford, Oxford, UK.
HLA-E is a nonclassical, nonpolymorphic, class Ib HLA molecule. Its primary function is to present a conserved nonamer peptide, termed VL9, derived from the signal sequence of classical MHC molecules to the NKG2x-CD94 receptors on NK cells and a subset of T lymphocytes. These receptors regulate the function of NK cells, and the importance of this role, which is conserved across mammalian species, probably accounts for the lack of genetic polymorphism.
View Article and Find Full Text PDFMicrobiome and Mucosal Immunity in the Intestinal Tract.
In Vivo
December 2024
Department of Gynecology and Gynecological Oncology, Research Laboratories, University Hospital Bonn, Bonn, Germany
The human bowel is exposed to numerous biotic and abiotic external noxious agents. Accordingly, the digestive tract is frequently involved in malfunctions within the organism. Together with the commensal intestinal flora, it regulates the immunological balance between inflammatory defense processes and immune tolerance.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!